Ask yourself: how is this article going to help me in treating my patients?
Here are what I think are the best articles for psychiatry residents to read (in addition to a basic textbook)
1. Theoretical aspects of competency assessment.
Importance: Competency assessment is one of the commonest consults our residents do and its principles are not easy to understand. A lucid and brief exposition is needed.
Best article found so far: Appelbaum PS, Grisso T. Assessing patients’ capacities to consent to treatment. N Engl J Med. 1988;319(25):1635-8. PubMed PMID: 3200278.
2. Practical aspects (the “how to”) of competency assessment.
Importance: Having stressed the importance of competency assessment and recommended an article on its principles, there remains the question of how to actually go about making the determinations that are needed for competency assessment.
Best articles found so far:
A) Mago R, Kunkel EJS, Stinnett J: Pearls in competency evaluations. Psychiatry 2006;3(2):20-21
B) Tunzi M. Tunzi M. Can the patient decide? Evaluating patient capacity in practice. Am Fam Physician. 2001;64(2):299-306. PubMed PMID:11476275.
3. Diagnosis and management of delirium.
Importance: one of the commonest problems in CL psychiatry. Its practical management is not discussed in textbooks at all. These articles are very readable and are full of dozens of practical recommendations. I have used the non-pharmacological suggestions from these article many times and used to even put on the medical chart a photocopy of the table listing the non-pharmacological suggestions.
Best articles found so far:
A) Meagher D: Delirium: Optimizing management. BMJ 2001;322:144–9
B) Brown TM, Boyle MF. Delirium. BMJ. 2002;325(7365):644-7.
4. Practical aspects (the “how to”) of suicide risk assessment.
Importance: This is needed to supplement the theoretical information in the textbooks because while broad principles and epidemiological risk factors, etc are discussed, the actual, practical process of assessment is not described beyond suggesting that a “comprehensive” (read: impossible to do at 2 am) assessment of the patient be done.
Best article found so far: Mago R, Certa K, Markov D, Kunkel EJS: Suicide risk assessments. Current Psychiatry 3(7):2-6, 2004. Available free at www.currentpsychiatry.com.
5. Psychopharmacology in the medically ill.
Importance: We routinely treat patients with comorbid medical problems and need to be aware of how to alter what and how we prescribe. However, it is hard to find succinct guidance on these issues.
Best article (book chapter) found so far: Robinson MJ, Owen JA. Psychopharmacology. In: Textbook of Psychosomatic Medicine.
6. False positive urine drug screens.
Importance: A high proportion of our patients are known to or suspected to abuse illicit drugs. Therefore, urine drug screens are one of the laboratory tests most frequently prescribed by psychiatrists. It is common for patients to protest that their UDS must be falsely positive and it behooves us to know when the patient may be telling the truth in this regard. It is also important for us to know about the difference between immunoassays and confirmatory tests in the UDS.
Best article found so far: Vincent EC, Zebelman A, Goodwin C, Stephens MM. Clinical inquiries. What common substances can cause false positives on urine screens for drugs of abuse? J Fam Pract. 2006;55(10):893-4, 897. PubMed PMID: 17014756.
7. “Difficult” patients.
Importance: While many patients arouse feelings of dislike in treating physicians, this issue is rarely discussed. A better understanding of these patients and some recommendations regarding how to deal with them will be clinically useful both for our own practices and for being able to guide others we work with.
Best article found so far: Groves JE. Taking care of the hateful patient. NEJM 298(16): 883-887
8. Laboratory monitoring in patients on second-generation antipsychotics
Best article found so far: American Diabetes Association; American Psychiatric Association; American Association of Clinical Endocrinologists; North American Association for the Study of Obesity. Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care. 2004;27(2):596-601. PMID: 14747245.
9. Best websites for clinical use by psychiatrists.
Best article found so far: Mago, R, Mahajan, R, Sciamanna, C: 12 best Web sites for clinical needs. Current Psychiatry 7(11):47-8, 2008. Available free at www.currentpsychiatry.com
10. Managing grief at the end of life.
Best article found so far: Periyakoil VS, Hallenbeck J: Identifying and managing preparatory grief and depression at the end of life. Am Fam Physician. 2002 Mar 1;65(5):883-90. PMID: 11898960.
11. Use of psychotropic medications in pregnancy and lactation.
Importance: While most of us don’t have many patients who are pregnant/lactating, residents in first and second year do occasionally treat pregnant patients. In addition, we all have many patients who may become pregnant while on psychotropic medications. Thus, while this knowledge is not useful frequently, we should all be familiar with the general principles and main concerns in using psychotropic medications in women who may become pregnant (planned or accidental). Also, we should know which article to go to when we have a clinical situation that warrants this.
Best article found so far: ACOG Committee on Practice Bulletins–Obstetrics. ACOG Practice Bulletin: Clinical management guidelines for obstetrician-gynecologists number 92, April 2008. Use of psychiatric medications during pregnancy and lactation. Obstet Gynecol. 2008;111(4):1001-20. PubMed PMID:18378767.
12. Tardive dyskinesia: risk, counseling, monitoring, and treatment
Importance: Tardive dyskinesia has been a leading reason for psychiatrists being successfully sued. With antipsychotics becoming more and more frequently used for a variety of indications, even psychiatrists who don’t have many patients with schizophrenia are prescribing antipsychotics routinely. Though the incidence of TD with second-generation antipsychotics is much less than with first-generation antipsychotics, it is high enough (especially in the higher risk subgroups) that all psychiatrists are likely to encounter TD in their patients. Paradoxically, the lower incidence of TD with second-generation antipsychotics may be making psychiatrists less meticulous in discussing it with their patients, less vigilant and systematic in identifying it, and less knowledgeable (if at all!) in how to treat it.
Best articles found so far:
A) Munetz MR, Benjamin S. How to examine patients using the Abnormal Involuntary Movement Scale. Hosp Community Psychiatry. 1988;39(11):1172-7. PubMed PMID:2906320.
B) Gardos G. Tardive dyskinesia: How to prevent and treat a lingering nemesis. Current Psychiatry. 2003;2(10): 59-66. Available free at www.currentpsychiatry.com
13. How to deal with the problem of missed appointments.
Importance: One of the most significant problems in outpatient practice, and extremely prevalent in residents’ clinics. Missed appointments sabotage the treatment process at its root. In addition, they also lead to lost revenue. The residents will find it difficult to be successful in outpatient practice after graduation, both clinically and financially, if they don’t become expert at dealing with this problem.
Best article found so far: Mago, R, Mahajan, R, McFadden, R: Missed appointments: How to help patients to avoid them. Current Psychiatry 6(12):77-78, 2007. Available free at www.currentpsychiatry.com.
14. How to end treatment with patients when you are leaving.
Importance: Residents, by the very nature of their status, need to end treatment with their patients. This leads to a major shake up of their patient’s treatments. While there is no research data on this, experience suggests that a significant proportion of patients drops out of treatment or get destabilized when the treating resident changes. This topic is also of some importance in clinical practice after residency.
Best article found so far: Kay, A, Mago, R: Tips for telling your patient good-bye. Current Psychiatry 6(11):45-46, 2007. Available free at www.currentpsychiatry.com.
15. Psychodynamic Formulation.
Importance: The psychodynamic formulation is the key to understanding a patient in psychodynamic psychotherapy and guides the treatment.
Best article found so far: Perry S, Cooper AM, Michels R. The psychodynamic formulation: its purpose, structure, and clinical application. Am J Psychiatry. 1987;144(5):543-50. PubMed PMID: 3578562.
16. How to read an article about therapy or prevention.
Best articles found so far:
- Users’ Guides to the Medical Literature. II. How to Use an Article About Therapy or Prevention. A. Are the Results of the Study Valid? Guyatt G, Sackett D, Cook D, for the Evidence-Based Medicine Working Group. JAMA 1993;270(21):2598-2601
- Users’ Guides to the Medical Literature. II. How to Use an Article About Therapy or Prevention. B. What Were the Results and Will They Help Me in Caring for My Patients? Guyatt G, Sackett D, Cook D, for the Evidence-Based Medicine Working Group. JAMA 1994;271(1):59-63.
17. Treatment-Resistant Depression
Best article found so far: Thase ME. Therapeutic alternatives for difficult-to-treat depression: a narrative review of the state of the evidence. CNS Spectr. 2004;9(11):808-16, 818-21.
18. Adult ADHD
Best article found so far: Kooij SJ, Bejerot S, Blackwell A, et al. European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD. BMC Psychiatry. 2010;10:67. PubMed PMID: 20815868.
19. Psychodynamic aspects of psychopharmacology.
Best article found so far: Mintz D. Psychodynamic Psychopharmacology. Psychiatric Times 2011; 28(9). Available free at www.psychiatrictimes.com
20. General principles of psychopharmacology
Best articles found so far:
A. Glick ID, Balon RJ, Ballon J, Rovine D. Teaching pearls from the lost art of psychopharmacology. J Psychiatr Pract. 2009;15(5):423-6. PubMed PMID:19820559
B. Salzman C, Glick I, Keshavan MS. The 7 sins of psychopharmacology. J Clin Psychopharmacol. 2010;30(6):653-5. PubMed PMID: 21105274
Best articles for reference only and not to be read per se:
Cohen LM et al.: Update on psychotropic medication use in renal disease. Psychosomatics. 2004 Jan-Feb;45(1):34-48.
Sandson NB, Armstrong SC, Cozza KL. An overview of psychotropic drug-drug interactions. Psychosomatics. 2005 Sep-Oct;46(5):464-94. PMID: 16145193.
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